Spine
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Retrospective series. ⋯ It was observed that the Lenke description for structurality of proximal thoracic curves can effectively determine which curves need fusion and which curves do not. Because there was no difference among inclusion of a nonstructural proximal thoracic curve into fusion or solely fusing the main thoracic curve in terms of outcomes, extension of fusion to T2 or T3 is unnecessary. In this patient population, the question of what the upper extent of instrumentation should be could not be answered.
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An in vitro biomechanical study of different pedicle screw configuration usage on the thoracic spine using a cadaveric model. ⋯ Our results suggest that the most important factor for the acute postoperative stability of spinal fixation is the degree of preoperative or iatrogenic destabilization. The minimum amount of pedicle screws provides adequate stability when there is minimal destabilization of the spine. On the other hand, when anterior column release has been performed or instability exists before surgery, segmental pedicle screw fixation may be necessary to achieve adequate stability.
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Randomized Controlled Trial
A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis.
Parallel design, prospective, double-blind, randomized, controlled trial composed of two independent groups treated with a continuous infusion catheter (saline vs. Marcaine) placed into the iliac crest bone graft (ICBG) site. ⋯ Continuous infusion of 0.5% Marcaine at the ICBG harvest site reduced postoperative parenteral narcotic usage by 50% and decreased overall pain scores. No complications were attributed to the infusion-catheter system. The use of continuous local anesthetic infusion at the iliac crest may help in alleviating acute graft-related pain, hastening patient recovery and improving short-term satisfaction.
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Review Case Reports
Acute quadriparesis caused by calcification of the entire cervical ligamentum flavum in a white female--report of an unusual case and a brief review of the literature: case report.
Case report. ⋯ To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.
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Literature review. ⋯ Physician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.